FIRST REGULAR SESSION
94TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES SCHAAF (Sponsor), COOPER (155), ONDER, PAGE, WRIGHT, FISHER, WHORTON, EMERY AND MEINERS (Co-sponsors).
Pre-filed January 2, 2007 and copies ordered printed.
D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal section 334.735, RSMo, and to enact in lieu thereof three new sections relating to medical professionals.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 334.735, RSMo, is repealed and three new sections enacted in lieu thereof, to be known as sections 334.108, 334.735, and 334.751, to read as follows:
334.108. Any medical student who has completed two years of medical school at any medical school which currently has received accreditation from the accrediting bodies of either the American Osteopathic Association or the American Medical Association and has entered the clinical rotation phase of their training shall have the same rights and privileges as those granted under 304.104, RSMo, subject to the written approval of the medical school and any attending physician responsible for their training.
334.735. 1. As used in sections 334.735 to 334.749, the following terms mean:
(1) "Applicant", any individual who seeks to become licensed as a physician assistant;
(2) "Certification" or "registration", a process by a certifying entity that grants recognition to applicants meeting predetermined qualifications specified by such certifying entity;
(3) "Certifying entity", the nongovernmental agency or association which certifies or registers individuals who have completed academic and training requirements;
(4) "Department", the department of economic development or a designated agency thereof;
(5) "License", a document issued to an applicant by the department acknowledging that the applicant is entitled to practice as a physician assistant;
(6) "Physician assistant", a person who has graduated from a physician assistant program accredited by the American Medical Association's Committee on Allied Health Education and Accreditation or by its successor agency, who has passed the certifying examination administered by the National Commission on Certification of Physician Assistants and has active certification by the National Commission on Certification of Physician Assistants who provides health care services delegated by a licensed physician. A person who has been employed as a physician assistant for three years prior to August 28, 1989, who has passed the National Commission on Certification of Physician Assistants examination, and has active certification of the National Commission on Certification of Physician Assistants;
(7) "Recognition", the formal process of becoming a certifying entity as required by the provisions of sections 334.735 to 334.749;
(8) "Supervision", [control exercised over a physician assistant working within the same office facility of the supervising physician except a physician assistant may make follow-up patient examinations in hospitals, nursing homes and correctional facilities, each such examination being reviewed, approved and signed by the supervising physician] overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant. The supervising physician shall at all times be immediately available to the physician assistant for consultation, assistance, or intervention either personally or via telecommunications. A supervising physician shall be personally present for practice supervision and collaboration a minimum of eighty percent of clinic hours in any clinic location utilizing physician's assistants. The physician assistant shall be limited to practice at the supervising physician's primary location of practice and where the supervising physician is able to be physically present at the location within thirty minutes so that there is no impediment to effective intervention and supervision of patient care. A supervising physician shall be engaged in the full-time practice of medicine and hold an active license to practice. The board shall promulgate rules pursuant to chapter 536, RSMo, for the [proximity of practice between the physician assistant and the supervising physician and] documentation of joint review of the physician assistant activity by the supervising physician and the physician assistant.
2. The scope of practice of a physician assistant shall consist only of the following services and procedures:
(1) Taking patient histories;
(2) Performing physical examinations of a patient;
(3) Performing or assisting in the performance of routine office laboratory and patient screening procedures;
(4) Performing routine therapeutic procedures;
(5) Recording diagnostic impressions and evaluating situations calling for attention of a physician to institute treatment procedures;
(6) Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by a licensed physician;
(7) Assisting the supervising physician in institutional settings, including reviewing of treatment plans, ordering of tests and diagnostic laboratory and radiological services, and ordering of therapies, using procedures reviewed and approved by a licensed physician;
(8) Assisting in surgery;
(9) Performing such other tasks not prohibited by law under the supervision of a licensed physician as the [physician's] physician assistant has been trained and is proficient to perform;
(10) Physician assistants shall not perform abortions.
3. Physician assistants shall not prescribe nor dispense any drug, medicine, device or therapy independent of consultation with the supervising physician, nor prescribe lenses, prisms or contact lenses for the aid, relief or correction of vision or the measurement of visual power or visual efficiency of the human eye, nor administer or monitor general or regional block anesthesia during diagnostic tests, surgery or obstetric procedures. Prescribing and dispensing of drugs, medications, devices or therapies by a physician assistant shall be pursuant to a physician assistant supervision agreement which is specific to the clinical conditions treated by the supervising physician and the physician assistant shall be subject to the following:
(1) A physician assistant shall not prescribe controlled substances;
(2) The types of drugs, medications, devices or therapies prescribed or dispensed by a physician assistant shall be consistent with the scopes of practice of the physician assistant and the supervising physician;
(3) All prescriptions shall conform with state and federal laws and regulations and shall include the name, address and telephone number of the physician assistant and the supervising physician;
(4) A physician assistant or advanced practice nurse as defined in section 335.016, RSMo, may request, receive and sign for noncontrolled professional samples and may distribute professional samples to patients;
(5) A physician assistant shall not prescribe any drugs, medicines, devices or therapies the supervising physician is not qualified or authorized to prescribe; and
(6) A physician assistant may only dispense starter doses of medication to cover a period of time for seventy-two hours or less.
4. A physician assistant shall clearly identify himself or herself as a physician assistant and shall [not] specifically inform each patient seen of his or her status as a physician assistant and shall specifically inform each patient that he or she has the opportunity to be seen by the supervising physician. No physician assistant shall use or permit to be used in the physician assistant's behalf the terms "doctor", "Dr." or "doc" nor hold himself or herself out in any way to be a physician or surgeon. No physician assistant shall practice or attempt to practice without physician supervision or in any location where the supervising physician is not immediately available for consultation, assistance and intervention, except in an emergency situation, nor shall any physician assistant bill a patient independently or directly for any services or procedure by the physician assistant.
5. For purposes of this section, the licensing of physician assistants shall take place within processes established by the state board of registration for the healing arts through rule and regulation. The board of healing arts is authorized to establish rules pursuant to chapter 536, RSMo, establishing licensing and renewal procedures, supervision, supervision agreements, fees, and addressing such other matters as are necessary to protect the public and discipline the profession. An application for licensing may be denied or the license of a physician assistant may be suspended or revoked by the board in the same manner and for violation of the standards as set forth by section 334.100, or such other standards of conduct set by the board by rule or regulation. Persons licensed pursuant to the provisions of chapter 335, RSMo, shall not be required to be licensed as physician assistants. All applicants for physician assistant licensure who complete their physician assistant training program after January 1, 2007, shall have a master's degree in a health or medical science related field.
6. "Physician assistant supervision agreement" means a written agreement, jointly agreed-upon protocols or standing order between a supervising physician and a physician assistant, which provides for the delegation of health care services from a supervising physician to a physician assistant and the review of such services. In any physician assistant supervision agreement, the supervising physician and physician assistant shall designate the primary location where the supervising physician practices at least eighty percent of clinic hours. The board shall randomly review physician assistant supervision agreements and the practices of physician assistants and supervising physicians under such agreements.
7. When a physician assistant supervision agreement is utilized to provide health care services for conditions other than acute self-limited or well-defined problems, the supervising physician or other physician designated in the supervision agreement shall see the patient for evaluation and approve or formulate the plan of treatment for new or significantly changed conditions as soon as practical, but in no case more than two weeks after the patient has been seen by the physician assistant.
8. At all times the physician is responsible for the oversight of the activities of, and accepts responsibility for, health care services rendered by the physician assistant.
9. No physician shall be designated to service as supervising physician for more than three licensed physician assistants. Physicians who have also been designated as a collaborative practice physician under section 334.101, shall only supervise a total of three either licensed physician assistants or collaborative practice registered professional nurses, or a combination thereof. This limitation shall not apply to physician assistant agreements of hospital employees providing inpatient care services in hospitals as defined in chapter 197, RSMo.
10. It is the responsibility of the supervising physician to determine and document the completion of at least a one-month period of time during which the licensed physician assistant shall practice with a supervising physician continuously present before practicing in a setting where a supervising physician is not continuously present.
11. It shall be void and against public policy for any contract or other agreement entered into with a physician to:
(a) Require the physician as a condition of employment to act as a supervising physician for any physician assistant;
(b) Limit the supervising physician's ultimate authority over any protocols or standing orders or in the delegation of the physician's authority to any physician assistant; or
(c) Require the physician to be employed by a licensed physician assistant being supervised under this section or a registered professional nurse in collaboration by such physician under section 334.104, or for a physician to be employed by an entity with whom the physician assistant or registered professional nurse has a financial relationship. A financial relationship exists if the physician assistant or immediate family member has a direct or indirect ownership or investment interest in the entity whether through equity, debt, or other means, or receives remuneration from a compensation arrangement from the entity.
334.751. Any hospital which employs an advanced practice nurse or a physician assistant shall allow any nonboard certified M.D. or D.O. physician to practice in the same hospital setting subject to the same credentialing procedures required of the advanced practiced nurse or physician assistant as long as those credentialing procedures do not discriminate against a nonboard-certified physician.
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